The Insurance Verification representative is directly responsible for the successful completion of all scheduled and unscheduled patient appointments: pre-registration, insurance eligibility and benefits verification, FSC assignment, and financial clearance. This position is responsible for independently resolving any insurance verification and financial clearance issue prior to an appointment; this involves contacting patients and insurance/third party payers to resolve eligibility and benefits issues and to initiate insurance appeals if necessary. This requires communicating with faculty practice managers, clinicians, staff and patients as needed and for discussing with patients: insurance benefits, insurance requirements, referrals, financial liability for physician services, and for securing method of payment.
Coordinates all aspects of securing accounts to include pre-registration, eligibility and benefits, and financial clearance using on-line systems to update and verify patient demographic and payer information.
Documents and updates all registration and financial data in the IDX system. Responsible for the correct identification and selection of appropriate insurance FSCs. Perform follow-up functions to correct deficiencies in data collection utilizing available systems such as Experian (MPV), eligibility systems, IDX, Eagle, and Ancillary systems.
Performs new or updated patient registration by capturing accurate, complete patient data to comply with billing and regulatory agencies requirements (Title XXII, OSHPD, DHS, CMS mandatory requirements); request and document clinical information that supports the service requested ensuring compliance with federal and state laws. Document any financial clearance issues through collection-specific coding and account notes for billing and follow-up communication.
Notifies patients about third party payer referral requirements, discuss insurance benefits and patient liability; secure and document commitment for payment of patient liability, including payment options for deductibles, co-pays, or estimated full fees if appropriate. Discuss and document method of payment, and financially clear accounts when arrangements have been finalized.
Obtains complete demographic and billing data collection from non-English speaking patients by arranging for Interpreting Services or other assistance as may be necessary to facilitate the completion of registration and financial clearance process.
Contacts patient prior to date of service to explain Columbia University payment policy, service charges, coverage/benefits, and patient liability. For self-pay patients, request information about mode of payment, establish payment plans if appropriate, and option of credit card payment.
Establishes communication with patients if necessary to inform them to reschedule appointments. Notify the appropriate Faculty Practice/physician’s office about cancellations and reschedule appointments based on patient’s medical needs and physician decision for patients who are not eligible for services or not authorized.
Conforms to all applicable HIPPA, Billing Compliance and safety policies and guidelines.
Minimum of 6 months to one year experience in a physician billing or third party payor environment. Proficiency in health insurance benefits, eligibility requirements and obtaining authorizations.
Knowledge of contracts, insurance billing requirements and HCFA 1500 claim forms, worker’s compensation, HMOs, PPOs, capitation, Medicare, Medicaid and compliance program regulations.
Good interpersonal, verbal, telephone and written communication skills in the English language.
Functional knowledge of basic computer operation and keyboard functions.
High school graduate or GED certificate.
Ability to follow-through and handle multiple tasks simultaneously.
Ability to work independently.
Some knowledge of electronic billing systems.
Must be a motivated individual with a positive attitude and exceptional work ethic.
Computer software skills (i.e. IDX, Eagle, Microsoft Word, Excel and E-mail, etc.).